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<html>
<head>
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    <title>申请代理</title>
</head>
<body>
    <header>
        <h1><span class="left"></span>申请代理
        <span class="right"><span class="id_1">ID:</span><span class="id">123456789</span></span>
    </h1>
    </header>
    <section class="sec_1">
        <img src="../static/img/app.jpg" alt="">
    </section>
    <section class="sec_2">
        <ul class="list">
            <h2>代理类型:</h2>
            <li><input type="radio" name="lei" checked class="all" value="all">全国代理</li>
            <li><input type="radio" name="lei" class="part" value="part">区域代理</li>
        </ul>
        <div class="div_1">
            <p>真实姓名: <input type="text" class="name_1" placeholder="请输入真实姓名"></p>
        </div>
        <div class="div_2">
            <p id="detail">
                <select class="province other" data-first-title="选择省">
                    <option value="" selected>选择省</option>
                    <option value="浙江省">浙江省</option>
                </select>
                <select class="city" data-first-title="选择市">
                    <option value="" selected>选择市</option>
                    <option value="杭州市">杭州市</option>
                </select>
                <select class="area" data-first-title="选择市">
                    <option value="" selected>选择县/区</option>
                    <option value="西湖区">西湖区</option>
                </select>
                <select class="jie" data-first-title="选择街道">选择街道</option>
                    <option value="" selected>选择街道</option>
                    <option value="中和街道">中和街道</option>
                </select>
            </p>
        </div>
        <ul class="list_2">
            <li>
                <p>代理份数:<input type="text" placeholder="请输入代理份数" class="num"></p>
            </li>
            <li>
                <p id="hang">申请行业:
                    <select class="select_1 other" data-first-title="选择省">
                        <option value="" selected>请选择</option>
                        <option value="浙江省">浙江省</option>
                    </select>
                </p>
            </li>
        </ul>
    </section>
    <div class="div_3">
        <button class="btn_1">提交审核</button>
    </div>

</body>
</html>